Healthcare Provider Details

I. General information

NPI: 1801807946
Provider Name (Legal Business Name): EDWARD WARREN KOLAR III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 FULTON ST DVAMC
DURHAM NC
27705-3875
US

IV. Provider business mailing address

508 FULTON STREET DVAMC
DURHAM NC
27705-3875
US

V. Phone/Fax

Practice location:
  • Phone: 919-255-1541
  • Fax: 919-255-1540
Mailing address:
  • Phone: 919-255-1541
  • Fax: 919-255-1540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0094-00547
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: